The Loot Drop
Research reviews for neurodivergent families
Issue #7 • February 2026
Why Your ADHD Meds Stop Working Once a Month
📋 SOURCE NOTE
This issue is based on a CHADD podcast interview with Dr. Dara Abraham, a board-certified psychiatrist specializing in reproductive psychiatry and ADHD. We've independently verified her claims against the peer-reviewed literature. Where evidence is strong, we say so. Where it's still emerging, we're transparent about that too.
⚡ TL;DR
Estrogen boosts dopamine. When estrogen drops (premenstrually, postpartum, perimenopause), so does dopamine, and your ADHD symptoms and medication effectiveness can tank. This isn't in your head. The neuroscience is real, but the research on women with ADHD is still catching up.
Legendary
Epic
Rare
Common
Key Findings
FINDING 01
Estrogen is dopamine's wingman
Estrogen increases dopamine synthesis and receptor availability while inhibiting the enzymes that break dopamine down. When estrogen drops during the luteal phase (roughly days 14-28 of your cycle), dopamine drops too. Since ADHD involves dopamine signaling differences, this hormonal shift can amplify symptoms and reduce how well stimulant medications work.
FINDING 02
Your premenstrual week isn't "just hormones"
A study tracking 32 women with hormone assays every other day found that decreased estradiol combined with elevated progesterone and testosterone predicted worse ADHD symptoms the following day. Separate research showed d-amphetamine produced greater effects during the follicular phase (when estrogen is high) compared to the luteal phase.
FINDING 03
Luteal-phase SSRIs work differently than you think
For PMDD (severe premenstrual symptoms), SSRIs taken only during the luteal phase are FDA-approved and effective. Unlike typical antidepressant use requiring weeks to work, research shows two-thirds of women achieved 50% symptom reduction within 2 days. The mechanism likely involves rapid modulation of neurosteroids, not the slow serotonin changes antidepressants usually rely on.
FINDING 04
Perimenopause hormone tests are mostly useless
NICE guidelines, ACOG, and the Endocrine Society all agree: don't bother testing FSH or estrogen levels in women 45+ with typical symptoms. Hormones fluctuate so wildly during perimenopause that a single blood draw tells you almost nothing. Diagnosis is clinical, based on symptoms and menstrual pattern changes.
Why It Matters
Half the ADHD population has been largely ignored by research
A review of 243 studies found that 81% of ADHD research participants were male, and among single-sex studies, 99.6% studied only males. A 2020 systematic review of medication trials found only 14 of 2,672 ADHD medication trials sorted results by sex. The DSM criteria, medication dosing, everything we "know" about ADHD was built on male bodies.
This matters because if you're a woman whose ADHD symptoms spike premenstrually, who struggled postpartum, or who suddenly can't function in perimenopause, you're not imagining things. Your neurobiology is real. The research just hasn't caught up yet.
This matters because if you're a woman whose ADHD symptoms spike premenstrually, who struggled postpartum, or who suddenly can't function in perimenopause, you're not imagining things. Your neurobiology is real. The research just hasn't caught up yet.
The Fine Print
Dr. Abraham's clinical insights align well with the basic neuroscience. But some claims need nuance, and the field has real gaps.
⚠️ NOTABLE
"No side effects" with luteal SSRIs is overstated
The FDA label for Sarafem (fluoxetine for PMDD) documents adverse events even with intermittent dosing: nausea in 14% vs 5% on placebo, plus headache and insomnia. What IS true: there's no withdrawal syndrome when stopping after the luteal phase, and side effects are generally reduced compared to continuous dosing. But "no side effects" isn't accurate.
⚠️ NOTABLE
The estrogen-dopamine-ADHD link needs bigger studies
The mechanism is well-established in basic neuroscience. But the clinical studies in women with ADHD are small (often under 50 participants) and short-term. We don't yet have large RCTs testing whether adjusting stimulant doses across the menstrual cycle actually improves outcomes. Clinicians are working from mechanism plus clinical observation, not definitive trials.
COUNTERPOINT
Continuous vs. luteal SSRI dosing is debated
A 2024 Cochrane review found continuous SSRI dosing "probably more effective" than luteal-phase dosing for PMDD. Other meta-analyses found no significant difference. If you try luteal dosing and it's not enough, continuous dosing remains an option. Worth noting: 68% of studies in that Cochrane review were pharmaceutical-funded.
Our take: The hormone-ADHD connection is biologically plausible and clinically observed by specialists who treat women daily. The basic science is solid. What's missing are the large-scale trials that would make this standard clinical guidance. In the meantime, tracking your symptoms across your cycle is low-risk and potentially high-reward.
What to Do With This
🧑🤝🧑 FOR WOMEN WITH ADHD
Track your symptoms alongside your cycle for 2-3 months. Note when your meds feel less effective, when focus crashes, when emotional dysregulation spikes. Apps like Clue or a simple spreadsheet work. This data gives you leverage in conversations with providers who might otherwise dismiss your experience as "just PMS."
If you notice a clear premenstrual pattern, ask your prescriber about: (1) adjusting stimulant timing or dose during the luteal phase, (2) luteal-phase SSRI for PMDD symptoms, or (3) evaluating whether hormonal contraceptives might help stabilize the cycle.
If you notice a clear premenstrual pattern, ask your prescriber about: (1) adjusting stimulant timing or dose during the luteal phase, (2) luteal-phase SSRI for PMDD symptoms, or (3) evaluating whether hormonal contraceptives might help stabilize the cycle.
👨👩👧 FOR PARENTS OF DAUGHTERS WITH ADHD
Puberty is a diagnostic window. Girls whose ADHD symptoms suddenly worsen or appear at puberty aren't "just being hormonal teenagers." The hormonal changes are real and affect brain chemistry. If your daughter was managing fine and then struggles after puberty, push for evaluation rather than assuming it's typical adolescent behavior.
Teach her to track her cycle early. Understanding her own patterns builds self-advocacy skills she'll need for decades.
Teach her to track her cycle early. Understanding her own patterns builds self-advocacy skills she'll need for decades.
🩺 FOR CLINICIANS
Ask about cycle timing when medication isn't working. If a patient reports their stimulant "stopped working" or has inconsistent response, menstrual cycle timing is a variable worth exploring before assuming tolerance or non-compliance.
For perimenopause: remember that hormone testing is unreliable. Diagnosis is clinical. The Eunethydis 2025 guidelines note that ADHD in women remains "under-recognised, under-researched, and under-treated."
For perimenopause: remember that hormone testing is unreliable. Diagnosis is clinical. The Eunethydis 2025 guidelines note that ADHD in women remains "under-recognised, under-researched, and under-treated."
🏆 THE BOTTOM LINE
If you're a woman with ADHD and your symptoms seem to have a life of their own depending on where you are in your cycle, the science backs you up. Estrogen and dopamine are connected, and when one drops, the other follows. The research on how to manage this is still catching up, but tracking your patterns and advocating for yourself with providers is a reasonable first step. You're not imagining it.